INTERWEIGH
SYSTEMS INC.

51 Bentley Street,
Markham, Ontario L3R 3L1

WEIGHT RECALIBRATION ORDER FORM

1. Customer Information:

Date: ________________________

2. Weight Calibration Information:

** Required information for calibration. The weight density and tolerance class (Class 1, Class 2, Class F etc) may be found on the original certificate at the time of purchase. It may also be on the Weight Case label.

3. Weight Cleaning:

Please note:
All weights will be verified prior to cleaning & calibration and will be recorded as 'As found' data.
All weights will then be cleaned and calibrated.
All weights will then be vervified after cleaning & calibration and will be recorded as 'As left' data.
This is the required method for ISO 17025: 2005 calibrations.

4. Weight Replacement: (if required)

If weights are found to be out-of-tolerance and can not be adjusted, Interweigh's policy is to contact the customer specified in #1 above and obtain authorization for a replacement weight, in the form of a revised or new purchase order. The rejected weight will be labeled as being out-of-tolerance and will be returned to the customer, unless specified differently.
Any new weights will be reported as 'As left', with a denoting asterisk.

5. Recalibration Interval: (in accordance with the requirements of your quality system)

Please indicate the calibration interval you wish to have Interweigh perform your weight calibrations, ie. "1 year" or "None" if you do not wish to have Interweigh contact you to ensure your weight's calibrations are kept up to date.
Recalibration Interval: _____________________

Note: If you specify an interval date, Interweigh will contact you approximately 1 month before the interval date to arrange for the recalibration. Please advise if you have any special instructions.

6. Safety Information:

Have any of the weights & protective cases being submitted for calibration been exposed to radiation, bio-hazardous materials or other hazardous containations?

No

Yes*

* if Yes, I hereby certifiy that these weights have been decontaminated by approved methods and are safe for handling.

7. Pick-up and Return Delivery: (please specify)

Interweigh offers a Pick-up and Delivery service to all Customers. For rates please contact us at 1-800-268-3269.

If you want to use your courier service please advise the following:

Please note: We have enclosed a Shipping Label for your use, as required.

ISI-035 Rev: 04/08/2009

Ship To:

Interweigh Systems Inc.
51 Bentley Street,
Markham, Ontario
L3R 3L1

Attn: Mass Calibration Laboratory